Reporting, Re-Contracting and Settlement

The SafeGuard Timeline

The SafeGuard Timeline Although SafeGuard involves a twelve month incurred contract period, USHL works with employers a full seventeen months in order to satisfy all stages of the program timeline All SafeGuard programs have five stages: Twelve month contract period Claims review period for re-contracting Plan reporting and re-contracting finalization and delivery Claims review period for settlement Settlement

SafeGuard Program Stages The SafeGuard program moves through several stages from inception to end: The contract period runs twelve months Reporting and re-contracting data are presented at month ten Incurred claims are processed for fifteen months Settlement and resulting funds distribution occur within five months after the contract end date* Any claims incurred within the contract period, but not received within the settlement period, will be covered by the incurred but not reported (IBNR) claims estimate * If a group terminates prior to the end of the twelve month contract period, settlement will still occur at the originally-scheduled date

Program Re-Contracting The re-contracting offer, delivered to the group in the tenth contract month, is based on underwriting review of the group’s claims experience within the first eight months of the twelve month contract period A prospective outlook is given for the group’s subsequent twelve months beyond the contract end date Employers wishing to continue to offer SafeGuard must re-contract with USHL for both administrative services and excess loss insurance coverage as each plan year contract is for twelve months and is not renewable There is no rollover of funds remaining in the pre-funded claims account; employers who re-contract will receive the applicable settlement payment from year one, and a new pre-funded claims account will be established for year two

Program Re-Contracting Re-contracting paperwork is delivered to the group in the plan’s tenth month The re-contracting offer is accompanied by an excess loss insurance application and administrative service agreement The group’s most recent quarterly wage / tax report must be included in the submittal

Program Re-Contracting The re-contracting offer identifies rates for the new plan year, along with the new year’s monthly payment breakdown USHL must be in receipt of all required re-contracting paperwork by the fifteenth day of month eleven to ensure no break in the group’s coverage

“A settlement check is like a group’s bonus for a healthy year.” Program Settlement “A settlement check is like a group’s bonus for a healthy year.”

What Happens at Settlement? SafeGuard is an incurred contract: Any eligible claim incurred during the twelve month contract period will be processed for payment according to plan guidelines The contract settlement period extends 90 days beyond the twelve month contract end date in order to allow time for incurred but not reported (IBNR) claims to reach USHL for processing

What Happens at Settlement? At the end of the settlement period, a determination is made on potential claims outstanding– yielding the IBNR Claims Estimate. This amount is held back from funds remaining in the pre-funded claims reserve account The remaining balance is returned to the employer within five months following the twelve month contract end date If a group terminates prior to the end of the twelve month contract period, settlement will still occur at the originally-scheduled date

Settlement Return Illustration

Program Reporting Provided in the tenth month of the contract period along with re-contracting rates Re-contracting documents identify pre-funded claims account balances on a monthly basis, group claims by type, claim payment advances and excess loss claim payments Groups with fifty or more enrolled receive reports showing non-member specific data: Information on claims paid, types of visits driving group medical costs, in-network versus out-of-network claims, generic versus brand drug usage, etc.

Program Reporting Each group receives a financial “balance sheet” of the plan showing month-by-month funds in and payments out– once during re-contracting and another, as shown, at the time of settlement.

Program Reporting Groups with 50+ enrolled also receive reports containing aggregate claims data– in-net vs. out-of-net, claim types, common illness analysis, etc.

For additional information on SafeGuard, select an option below: Speak with a Sales Representative Contact USHL Sales Support at (844) 828-5968 or send an email to SalesSupport@ushealthandlife.com Learn more about SafeGuard http://www.ushealthandlife.com/Find-a-Plan/Medical/SafeGuard Review SafeGuard Benefit Summaries http://www.ushealthandlife.com/Find-a-Plan/Medical/SafeGuard/Benefit-Summaries Review Frequently Asked Questions http://www.ushealthandlife.com/Portals/0/Documents/SafeGuard/SafeGuard_FAQs.pdf Obtain a Quote http://www.ushealthandlife.com/Find-a-Plan/Quotes-from-USHL/Get-a-Quote#SafeGuardQ Excess loss insurance policies and PPO insurance plans underwritten by US Health and Life Insurance Company, Inc.  SafeGuard plans administered by US Health and Life Insurance Company, Inc. © 2017 US Health and Life Insurance Company, Inc. All rights reserved.

Reporting, Re-Contracting and Settlement